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June 2011 Inpatient Pharmacy Workflow Processes and Daily Routine.

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Presentation on theme: "June 2011 Inpatient Pharmacy Workflow Processes and Daily Routine."— Presentation transcript:

1 June 2011 Inpatient Pharmacy Workflow Processes and Daily Routine

2 Course Objectives Identify at least two steps involved in developing a strategic plan for improving a health system's process for preparing Compounded Sterile Products (CSPs). Discuss the need for patient safety-related improvements in the process for preparing CSPs in many health-system pharmacy departments Leverage HIT, data management, and workflow to strive toward the patient-centered medical care model

3 Course Objectives Configure Inpatient Pharmacy v5.0 site parameters for IV and UD menus Compare & contrast Inpatient Pharmacy IV and UD reports Use Inpatient menu options to perform routine daily IV and UD tasks Identify good practices for managing workload using Inpatient Pharmacy v5.0

4 Overview Daily inpatient pharmacy workload: IV Package routine tasks: - Printing reports/lists, Printing Labels, Manufacturing of IV’s, etc. Unit Dose Package routine tasks: - Printing pick list, cart-fill (if no Pyxis), entering doses dispensed, etc.

5 IV Menu Site Parameter Configuration IV Menu > Supervisor Option > Site Parameter Edit Allows configuration of defaults: Name(s) of IV Room(s) Label specifications Duration of orders for various IV types: Automatic stop dates different from the defaults may be entered for individual additives in drug file Coverage times (i.e., 24 hour batch time frame) Devices for output (reports, labels)

6 Daily Routine for IV Package Print Active Order List (optional): Review, update orders as needed Print Ward List Print Manufacturing List Print Scheduled Labels Prepare IV’s, check, deliver to ward

7 Daily IV Workload – Active Order List Prints list of all currently active IV orders: Sorted by ward Can be printed at any time Variety of uses as a worksheet: Take to ward and check IV admixtures for current rates, # of bags needed. Use to review IV antibiotics against culture results. Compare to MAR to see if nurses changed any administration times.

8 Daily IV Workload – Ward List Ward List prints all active orders: Sorted by ward Shows # of bags due for 24 hour coverage First step in sequence for daily IV batch: Ward List, then Manufacturing List, then Scheduled Labels (always in this order) Ward List is used by pharmacist to check each bag/label prior to delivery to ward.

9 Daily IV Workload – Manufacturing List Prints all active orders: Lists all admixtures first: Sorted by base solution, with totals Lists all piggybacks next: Sorted by additive and strength, with totals Used by technicians to assemble needed bags & additives, record lot numbers. After admixture, technician separates IVs by ward for checking by pharmacist.

10 Daily IV Workload – Scheduled Labels Prints labels for all IVs due for 24 hour batch: Labels print in same order as manufacturer list (batched by drug/dose). Good practices: Check printer before sending print job: Ensure labels correctly aligned. Ensure adequate # of labels. Watch labels to ensure they don’t curl back.

11 Other IV Menu options: Reprint Scheduled Labels Shouldn’t need to use this often: Especially if you follow good practices and watch the printer during scheduled label print job If labels jam partway through print job or run out: Can print selected range of labels From last usable label to end, or to next usable label

12 Other IV Menu Options: Individual Labels Print labels for one patient Program gives two choices: Reprint labels Print New Labels Program asks if the labels should “count as daily usage?” No for reprints Yes for new labels

13 Other IV Menu Options: Suspense Functions Allows labels to be suspended from printing with the batch Labels can later be released for printing Possible uses: High cost items Items that may be discontinued Items unlikely to be re-usable: Neonatal syringes, oddball admixtures

14 Other IV Menu Options: Returns & Destroyed Menu Used when IVs or IV labels need to be credited Labels that were printed but never mixed: Use Cancelled option Labels that were printed and mixed but can be re-used for another patient: Use Recycled option Labels that were printed and mixed and cannot be used for another patient: Use Destroyed option

15 Other IV Menu Options: Renewal List & Inpatient Stop Order Notices Reports that print orders that will expire in a selected time frame (e.g. next 24 hours): Renewal List prints only IV orders. Inpatient Stop Order Notices prints IV orders, U/D orders, or both. If your site has automatic stop dates: Use report to notify providers. Provider must decide whether to renew or let order expire.

16 Automatic Stop Orders (ASO’s) Are ASO’s necessary? Helpful? Good practice suggestion: Eliminate ASO’s in policy for most drugs. Configure RPMS parameters to maximum allowable stop date. Exceptions to consider: ketorolac, narcotics? For the exceptions, can set shorter ASO under orderable item file or additive file.

17 UD Menu Site Parameter Configuration Unit Dose Menu > Supervisor Option > Inpatient Ward Parameters Edit Allows configuration of defaults: Automatic stop dates for UD orders Start time calculation: Now, Next Scheduled or Closest Scheduled Automatic printing of MAR labels Default print devices

18 Daily Routine Workload for Unit Dose (UD) Package Print Pick List* Perform cart fill if no ADM (Pyxis/Omnicell) Enter Units Dispensed* Report Returns* * Process differs depending on whether or not your site has Inpatient ADMs with Profiling and Interface

19 Daily UD Workload: Printing Pick List Pick list prints all active UD orders: Sorted by Ward, then Room/Bed Shows doses needed for next 24 hours Used as worksheet to fill UD med carts If Pyxis or Omnicell, do not need to actually print: Still need to RUN Pick List, but can print to screen or enter “^”

20 Pick List - with Cart Fill Number of units dispensed is recorded on line. Items marked Ward Stock will show WS as units needed. Orders that are schedule type R (Fill on Request) will show zero as units needed.

21 Daily UD Workload: Enter Units Dispensed Allows pharmacist to enter into RPMS the doses actually dispensed for each med: Tip: when appropriate, simply Enter at prompt to accept that units dispensed = units needed Optional: view only prn med orders: For schedule types other than prn, program assumes units dispensed = units needed Program jumps past items listed as WS: When finished, you are prompted: “May I file this pick list away”?

22 Daily UD Workload: Enter Units Dispensed (Sites with ADM) Bypassing Enter Units Dispensed entry: At first patient, enter “^^^” to skip to the end. Program automatically accepts units needed equals units dispensed for each item. Caution - if any item is not marked as WS the program will double count: Pick List doses plus doses removed from ADM Good Practice – do the complete Enter Units Dispensed, at least periodically.

23 Other UD Menu Options: EXtra Units Dispensed Used to enter extra unit doses dispensed: e.g., lost, dropped Fill on Request items (e.g. new tube of cream) For sites with ADM (Pyxis/Omnicell): Use this option if item not stocked in ADM. If item comes out of ADM and nurse removes extra dose, it is recorded automatically.

24 Other UD Menu Options: Report Returns Used to credit unit dose meds: When patient is discharged When order is discontinued If your site has ADM with interface: Meds returned to ADM by the nurse will be subtracted in RPMS automatically Still may need to use this option: e.g., Albuterol inhaler prn - dispensed but never opened/used

25 Summary Inpatient Package Daily Routine Tasks: IV Menu: Ward List, Mfg List, Scheduled Labels Other options as needed UD Menu: Pick List, +/- Cart Fill, Enter Units Dispensed Other options as needed

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